Disseminated Cryptococcosis with Rapidly Growing Lung Nodules in an End-stage Renal Disease Patient

Inaba, Atsushi; Okada, Akira; Yoshida, Taiko; Itoyama, Satoshi; Nakai, Tatsuro; Hisada, Tetsuya; Takano, Hideki

doi:10.2169/internalmedicine.56.7438

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…To our best knowledge, this was the first report to clarify the clinical manifestations of advanced CKD in patients with non-HIV pulmonary cryptococcosis. CKD is one of the risk factors for pulmonary cryptococcosis; this statement can be supported by several individual cases that had severe clinical manifestations, such as dissemination and mortality, in chronic renal failure, especially when under dialysis [14,20]. Pyrgos V et al reported that compared with all hospitalized patients, those hospitalized for cryptococcus meningitis had significantly more frequent comorbidities of acute (28.5%) and chronic renal failure (14.3%) [24].…”

Section: Discussionmentioning

confidence: 96%

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Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

et al. 2020

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Background: Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. Methods: The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) > 45 mL/min/1.73 m 2 (n = 42, early CKD) and those with eGFR < 45 mL/min/1.73 m 2 (n = 14, advanced CKD. Results: Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p < 0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p < 0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65-20.09], p < 0.01), high white blood cell count (1293.2 [110.2-2476.2], p = 0.03), Creactive protein (0.89 [0.18-1.59], p = 0.01) and low level of serum albumin (− 0.34 [− 0.54-− 0.14], p < 0.01) in patients with eGFR < 45 mL/min/1.73m 2. Conclusion: Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis. Trial registration: The patients in this study were registered retrospectively.

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Section: Discussionmentioning

confidence: 96%

“…There is increasing evidence that CKD is closely linked with host immune systems [18] and the risk for infections [19]. Some reports identified that the severity of CKD was involved with the clinical characteristics of pulmonary cryptococcosis [20,21]; however, the clinical features have not been fully assessed.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

et al. 2020

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“…CKD is one of the risk factors for pulmonary cryptococcosis; this statement can be supported by several individual cases that had severe clinical manifestations, such as dissemination and mortality, in chronic renal failure, especially when under dialysis (14,20). Pyrgos V et al reported that compared with all hospitalized patients, those hospitalized for cryptococcus meningitis had significantly more frequent comorbidities of acute (28.5%) and chronic renal failure (14.3%) (24).…”

Section: Discussionmentioning

confidence: 96%

Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

Tashiro

Haraguchi

Takahashi

et al. 2020

Preprint

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Background Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. Methods The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018.The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) >45 mL/min/1.73 m2 (n = 42, early CKD) and those with eGFR <45 mL/min/1.73 m2 (n = 14, advanced CKD. Results Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p <0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p <0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65 – 20.09], p <0.01), high white blood cell count (1293.2 [110.2 – 2476.2], p = 0.03), C-reactive protein (0.89 [0.18 – 1.59], p = 0.01) and low level of serum albumin (- 0.34 [-0.54 – -0.14], p <0.01) in patients with eGFR <45 mL/min/1.73m2. Conclusion Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis.

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“…Currently, it is becoming an important infection in human immunodeficiency virus-negative patients [ 11 ], particularly in those with significant underlying immunosuppression such as organ transplant, long-term glucocorticoid treatment, hematologic malignancies, diabetes mellitus, hepatic cirrhosis, among others [ 12 , 13 ]. In China, pulmonary cryptococcosis ranked as the third most common pulmonary fungal infection, and most Chinese patients with pulmonary cryptococcosis do not have underlying diseases [ 14 ]. Our patient was an immunocompetent patient without an immunity-associated medical history.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature

Zeng

Zhou

et al. 2018

J Med Case Reports

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BackgroundPulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuberculosis, malignant tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor is rarely presented.Case presentationA 52-year-old immunocompetent Han Chinese woman was presented to our emergency department complaining of headache and vomiting accompanied by postural changes. She was diagnosed with pulmonary cryptococcosis according to results of laboratory tests, computed tomography, and percutaneous lung biopsy. Owing to the poor therapeutic effects of 6-month fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. Delayed treatment of malignant tumor resulted in lymph node metastasis, higher pathologic stage, and probably poorer prognosis.ConclusionsOur patient’s case serves as a reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.

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Disseminated Cryptococcosis with Rapidly Growing Lung Nodules in an End-stage Renal Disease Patient

Cited by 10 publications

References 22 publications

Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature

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